Value of On-Site Cannabis Dispensaries Is Missed in Federal Regulations

08/28/2015 08:02 EDT
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Updated
08/28/2016 05:59 EDT

Jenna Valleriani
PhD Candidate in Sociology and the Collaborative Program in Addiction Studies at the University of Toronto

Lew Robertson/Fuse via Getty Images

Marijuana with vintage bottles

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The chief executive officer of the BC Pharmacy Association wants the newly regulated medical cannabis dispensaries in B.C. to be restricted from calling themselves "dispensaries."

Where have they been for the last 18 years?

While the new dispensary bylaws in Vancouver seem to trace out a distinction between non-profit "compassion clubs" and dispensaries, I don't think you'll be seeing too much confusion from Vancouverites on what exactly is being dispensed at these locations.

When it comes down to it, it's really just another war around language. Pharmacies certainly don't have jurisdiction over the word 'dispensary.' In fact, I don't think I would even associate that word with a pharmacy. Quite literally, the word only means "a place where something is dispensed, especially medicine."

Furthermore, dispensing "medical" cannabis to patients seems to fit the bill, even if it's loose. While the BC Pharmacy Association may side with Health Canada who loves to remind us that cannabis is not approved as a prescription drug because it "has not gone through the necessary rigorous scientific trials for efficacy or safety," I believe that patient experiences speak for themselves, and is really a question of the hierarchical ways we define "expert knowledge."

Why now? Aside from the regulation of dispensaries in the city (where the public hearings on regulation of dispensaries would have been an appropriate venue to voice these concerns), there has been a lot of discussion reverting back to the early Marihuana for Medical Purposes Regulations (MMPR) that included pharmacy distribution, which pharmacists wanted nothing to do with. But, in all of our discussions on what 'gaps' need to be addressed under the MMPR, the lack of onsite distribution comes up again and again, and is one of the major reasons for the continued proliferation of dispensaries across Canada.

It's certainly a more patient-focused option, where usually patients who access dispensaries are often given the option of coming in or having it mailed. Some even offer local delivery for registered members. From the perspective of someone who worked at a dispensary while starting my research (mostly in membership coordination and patient education) I might be a bit biased, but let me explain why.

During the tail end of this job -- the last few months before the MMPR came into effect -- the demographics of new patients were mostly older baby boomers with little to no experience with cannabis. Some had perhaps tried cannabis in the younger years, but most were venturing into unknown territory. Why? Most of them had run out of options, turning to cannabis as a last resort.

Would you believe that most of these sessions included not just your typical orientation, but actually showing them what cannabis looks like, smells like, and demonstrating how they could use various routes of administration, like pipes, joints and vaporizers? Moving from seeing and smelling, to breaking up the cannabis, it was also necessary to show new patients how they could use these various tools for administration (truthfully though, can you imagine a pharmacists demonstrating this on the desk of their counseling room?)

With that, I find it hard to believe that a program that offers mail delivery only serves these patients. It's wrong to assume that all medical cannabis patients under the MMPR have experience with cannabis. Even if they did smoke a few 'doobies' in their youth, learning how to self-titrate in an effective way to manage one's symptoms is very different. Coupling this with common truths under the MMPR like minimum orders, shipping costs, lack of product exchange options, and the sometimes inconsistent availability of strains, it becomes even harder.

While it's true dispensaries probably do not offer consistent availability of the same strains (as one example), patients can still go in and talk to someone, ask for something similar, and see and smell the available options. While I still think mail delivery is a necessary option for accessibility, particularly for those with physical limitations, those who are too ill to pick up their medicine and those who live outside of major cities, it just isn't enough.

I even recall employees at the dispensary rolling up to an ounce of cannabis for particularly special cases and delivering it directly to the patients who needed it the most. For example, one woman who suffered from MS and had lost a lot of her motor functions; although cannabis improved her quality of daily living, without this service she would be unable to prepare her cannabis herself because she did not have any family and relied on a single hired caregiver for help. I wonder what she would do if she was registered with the MMPR, where rolling up cannabis is considered suggesting a dose and is not an available option through LPs.

What could distribution look like under the MMPR? Forgetting that dispensaries exist for a second, there is the option of pharmacy distribution (although unlikely), LPs selling wholesale to retail type storefronts, or the regulations allowing for LPs to open their own storefront location with the option of onsite dispensing. I'd be willing to bet that LPs don't want to let go of distribution, and many will refuse to work with dispensaries as they currently exist. For it to really work, something entirely new will need to emerge.